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Mind-Body Medicine: A Balanced Approach

Dr. Herbert Benson and colleagues talk about the Relaxation Response and the current role of mind-body techniques in wellness and medical care.

By Rosalind Gray Davis on Apr 30, 2008

“My goal has always been to promote a
healthy balance between self-care approaches and more traditional
approaches—medical and surgical inter­ventions that can be magnificent and
lifesaving when appropriate. However, self-care is immensely powerful in its own
right. The elicitation of the Relaxation Response, stress management, regular
exercise, good nutrition, and the power of belief all have a tremendous role to
play in our healing.”

—Herbert Benson, MD

The Relaxation Response

Herbert Benson, the doctor who defined the
Relaxation Response,
is hailed as a visionary, a pioneer, a
dedicated cardiologist who has devoted much of his nearly 40-year career to the
fields of behavioral medicine and mind-body studies. Director emeritus of the
Benson-Henry Institute for Mind Body Medicine (BHI) at Massachusetts General
Hospital and associate professor of medicine at Harvard Medical School’s
Mind/Body Medical Institute, he continues to teach and lead cutting-edge
research on ways to counteract the harmful effects of stress. Dr. Benson
recently agreed to an interview with IDEA Fitness Journal.

Seeds of Change

Benson’s own journey establishing the
mind-body connection began, as he recalls, “in the middle 1960s, when I noticed
that people’s blood pressures were higher during visits to my office than at
other times and wondered whether stress wasn’t causing that rise. Stress wasn’t
on the radar then, so I began investigating a connection between stress and
hypertension.” To this end, he returned to physiology research at Harvard to
develop a model for stress-induced hypertension using biofeedback technology
with monkeys.

On hearing of Dr. Benson’s work on stress and hypertension with
animals, a group of Transcendental Meditation (TM) practitioners met with him,
stating that they could lower their blood pressure simply by meditating. After
what he terms “considerable hesitation,” he agreed to study them. “I
collaborated with Robert Keith Wallace of the University of California, Irvine,
who was performing similar experiments.” After compiling the data, he and
Wallace found that “with meditation alone, the TM practitioners brought about
striking physiologic changes—a drop in heart rate, metabolic rate and breathing
rate—that I would subsequently label ‘the Relaxation Response.’” [Drs. Wallace
and Archie F. Wilson simultaneously conducted similar studies with TM
practitioners in California. Later, Wallace joined Dr. Benson at Harvard, where
they continued their collaboration.]

Coincidentally, it was in the very room where Benson studied the
TM adherents that 60 years earlier Harvard physiologist Walter B. Cannon
discovered the
“fight-or-flight” response,
also known as the stress
response.
Human beings developed this primitive physiologic
response as a mechanism for surviving stressful situations. As Benson explains,
“Our bodies release hormones—adrenaline and noradrenaline, or epinephrine and
norepinephrine—to increase heart rate, breathing rate, blood pressure,
metabolic rate and blood flow to the muscles, gearing our bodies either to do
battle with an opponent or to flee.” Benson’s own research showed that the polar opposite was also true:
“The body is imbued with what I termed the Relaxation Response, an inducible,
physiologic state of quietude.” Teaching people why that quietude is important
and how to induce it has been a major focus of Dr. Benson’s work ever since.

“The world is so fast-paced, and it is excitatory,” says Benson.
“People think they need more and more excitement to shut their minds off. But,
in truth, it is just the opposite. They have to find periods of quietude to
rejuvenate, to rebuild their resiliency. People are undergoing changes in the
way they think, . . . cognitive restructuring, because they are always looking
for [something] new and exciting.” What they really need is to find a balance
in their lives, he says, and one of the most effective means of doing that is
by incorporating the Relaxation Response into their daily activities.

It has to be something they do daily, he explains, to have “its
long-term effects, to have the physical changes in the body—such as brain
thickening, such as changes in metabolism. . . . It is what people used to do.
Think of our parents or grandparents—they used to pray regularly or they used
to do routine exercise. This has left our modern world.”

For instructions on Dr. Benson’s method of relaxation, see the
sidebar “How to Elicit the Relaxation Response.”

Integrative Health Care: The Three-Legged Stool

When Dr. Benson founded the Mind/Body
Medical Institute in 1988 at Beth Israel Deaconess Medical Center in Boston,
his goal was to enhance traditional medical approaches, such as pharmaceuticals
and surgery, by cultivating people’s natural capacity to heal. The BHI (at
Massachusetts General) opened on December 1, 2006, an important next step that
Benson’s colleagues say provides huge growth potential, especially for
cutting-edge research in behavioral medicine. The institute’s current
literature describes it as a nonprofit scientific and educational organization
dedicated to research, teaching and the clinical application of mind-body
medicine and its integration into all areas of health. The “Henry” in the name
is John Henry, principal owner of the Boston Red Sox and a member of the BHI’s
board of trustees.

Benson likens his ideal model for optimal health care to a
“three-legged stool.” This model provides a means of achieving better, more
balanced care for the patient, he believes. One leg of the stool represents pharmaceuticals;
a second represents surgery
and procedures;
and the third is self-care, the
strategies the patient uses to enhance his or her natural capacity to heal.

“Health and well-being is an end-point,” he says, “and to achieve
that, most people believe that drugs and surgeries are necessary steps, but
there has to be a third leg to that stool, and that is self-care. Self-care is
so important because 60%–90% of visits to doctors are related to stress and
[are] poorly treated, if treated at all, by drugs or surgeries. So you need
that self-care leg, and within self-care you obviously have the Relaxation
Response, nutrition, exercise and socialization, and we also have belief and
spirituality. What we have to do is learn to respect [self-care’s] importance
and then integrate pharmaceuticals, surgery and self-care together.” Benson
firmly believes that self-care “is a vital next step” in our current medical environment.

An important key to adequate health and well-being, Benson
emphasizes, is integration. “There is no substitute for good surgery, there is
no substitute for appropriate drugs, and there is no substitute for helping
yourself help yourself. They work together. This is a vital point because it
would be inappropriate and inaccurate to believe there is a one-legged stool,
where self-care was all you needed.”

Could the self-care approach save the patient and the medical
system money? “Oh, without question,” Benson says. “Why should you be spending
for drugs that you don’t need or surgeries that you don’t need? But you need a
doctor making that decision. I mean it would be tragic if one believed only in
self-care and gave up, for example, penicillin that could save your life.”

For patients’ views on how BHI programs are applying the
principles of integration, see the sidebar “A Sustainable ‘Whole-Life’
Approach.”

Stress and Resilience

In Benson’s view, understanding stress is
a critical element in self-care and mind-body medicine—and a necessary step in
learning to appreciate the healing capacities of the Relaxation Response. He
defines stress as “any situation that requires behavioral adjustment, whether
it is good or bad. A marriage is stressful; so is a divorce. In other words,
[stress] is anything to which you have to adjust, and sometimes those changes
to which you have to adjust are life-threatening: to avoid an accident, to avoid
an attack by another; sometimes they’re worries about your health, your
family’s health, worries about your financial situation, which means an
adjustment. They all require behavioral adjustment.”

Nurse practitioner Peg Baim, MS, is the clinical director of the
Center for Training in Mind/Body Medicine and a researcher at the BHI. As part
of Harvard Medical School’s department of continuing education, she teaches
classes and seminars with Dr. Benson on the science of stress and how self-care
strategies work. Baim says, “If you think about the stress system, it’s the
physiology within the body that gets recruited to bring it back into balance
whenever it has been challenged. So, if we are too cold, or hungry, or if we
are experiencing anxiety or sadness, all of that is going to change the body in
such a way as to activate the stress system, which then works harder to get the
body back into the narrow parameters of health.”

Baim explains that we have an intricate network of communications
“within our hormones, our neuropeptides, and within ourselves.” (Neuropeptides—some
of which are endorphins—influence neural activity or functioning.) She
describes the communication network as a delicate system of checks and balances
that, if taxed too much, depending on our biology, our inherited features and
our environmental vulnerabilities, “becomes ‘disregulated,’ and we lose those
extremely delicate feedback loops and start expressing illnesses or symptoms.” Allostatic
systems
allow our bodies to remain healthy by their capacity
for change and adaptation; they include parts of the nervous system that
control heartbeat, blood pressure and similar functions, as well as glands that
collaborate to produce hormonal responses. The wear and tear that results from
chronic overactivity or underactivity of allostatic systems, says Baim, is
called our
allostatic load.

On the other hand, she notes that allostasis is the
equivalent of resilience. Resilience, Baim clarifies, “is adaptation
through change. That’s really what our body is doing; our body is constantly
adapting. We’re adapting to our signals of hunger, low blood sugar, inactivity,
or to an individual’s anger, or to being cut off in traffic. When we adapt
successfully and we can still stay within the narrow parameters of health,
that’s referred to as allostasis or resilience.”

To support resilience, Baim says, people need recuperative sleep,
stress man­agement in terms of cognitive re­struc­turing, stress management in
terms of methods that elicit the Relaxation Response, a healthy diet, physical
activity and social support. She says the Relaxation Response fits into the
health equation because “you can’t be psychologically activating the stress
system when you are in the Relaxation Response. So it is as if you can’t be hot
and cold at the same time.”

When you practice the Relaxation Response, according to Baim, you
are actually activating the areas of the brain that have been positively
conditioned, rather than those that have been negatively conditioned. “You tend
to feel compassion, forgiveness and oneness as opposed to the stress response,
where you feel hatred, resentment and [separation]. It is as if we have two
different brains.” She says people can elicit the Relaxation Response, using a
variety of serviceable techniques, including contemplation, imagery and
mindfulness (see the sidebar “How to Elicit the Relaxation Response”).

Baim thinks that many people have lost the positive behaviors
that promote resilience, leaving them vulnerable to their negatively
conditioned habits and beliefs. The result is chronic activation of the stress
response: “It is amazing to me how easily people get angry, how quickly people
become impatient; you see, people are really living off their last nerve. The
more you live in this stress response, the more you are depleting your
serotonin, your dopamine. There is less activation of the cells that secrete
serotonin, dopamine and your endogenous opiates, and so it doesn’t feel good to
be alive. I think it is very telling that we have an epidemic of depression in
school-age children in the United States, for example; that’s a scandal.”

At the BHI, therapeutic cognitive restructuring techniques
[changing the way we think and perceive a given event] are taught to assist
people in beginning to think positively again. Therapists suggest that the best
way to do this is first to identify thoughts and beliefs that are irrational
and self-defeating; next to learn about new ways of thinking; and finally to
practice them until they become second nature.

The Role of Exercise in Allostasis

Exercise, Baim says, has always played a
major role in bolstering the resilience we need to keep stress in check.
“Exercise is in and of itself an antioxidant, and stress is an oxidant. Stress
is wearing and tearing the body down with more inflammatory molecules, and
exercise is actually allowing the body to release molecules that will
deactivate that inflammation.”

Jim Huddleston, MS, physical therapist, exercise physiologist and
researcher at the BHI, says the idea is for people to find their own balance in
the realms of exercise, diet, relaxation and dealing with life stresses. “It is
about trying to develop a good homeostasis and balance. That’s why I like yoga,
tai chi and Pilates so much; they really help you physically, emotionally and
spiritually get better balance. Applying the Relaxation Response to exercise
also brings you to that better balance. There is always some new inherent
learning experience in a mindful exercise practice.

“The Eastern traditions have that inherent mindfulness built in,”
he says, “but you can do it with aerobic exercise, with resistance training; as
long as you have the mindset, you can do it with any type of exercise. I like
adding that other mindfulness element because [it makes exercise] about total
health rather than just fitness, because you are involving the whole body in
the process.”

Huddleston notes that there are two criteria for eliciting the
Relaxation Response during exercise: focus and an open
attitude.
These can be accomplished by paying attention to
either the breath or the cadence of the activity. “If walking, [people] can
focus on the cadence, and if they need to make that more concrete and
objective, they can count their steps,” says Huddleston. “People can develop a
mantra that they say over and over to themselves in the rhythm of the breath
and the rhythm of their walk. This can be accomplished with a standard
four-beat count or, if their mind tends to wander, a three-beat count, which
puts them off a bit—as long as they have something on which to focus their
awareness, so they are not caught up in the extra thinking that we always do,
either in the past or in the future. That tends to get us into problems.

“The other criterion, open attitude,” he adds, “is about the
experience they are having—not being judgmental or critical or setting certain
expectations for themselves about the experience. It is observing what happens
with the experience.”

Partnering for Prevention

An integral member of the BHI’s Cardiac
Wellness and Lighten Up: Weight Management programs, Huddleston reiterates Dr.
Benson’s belief in integration as the foundation for their philosophy. “It is
really about helping the [patients] become more responsible for themselves,” he
says.

He believes that the healthcare habits people develop can help
them maximize their potential. Raising their awareness of what’s healthy and
what’s not is a theme that underlies all the BHI programs. “When [people] are
more aware, they have more control, and when they have more control, they can
make better choices,” he says. Huddleston adds that the medical system needs to
“move more into a preventative mode and out of the reactive mode. It is not a
healthcare system; it is a sick-care system. We need to concentrate more on
being a healthcare system and encourage people to be more responsible for
taking care of themselves.”

Asked whether mind-body medicine is presently an equal, fully
respected partner in Western medicine, Dr. Benson responds: “No, but it is on
the table, and many people are accepting it as an important feature within the
medical profession. We are now part of Mas­sachusetts General [the oldest and
largest teaching hospital of Harvard Medical School], and that shows where [the
BHI] should be based—within a medical establishment. Mass General is
world-class with respect to its surgery and with respect to its pharmaceuticals.
This institution has now recognized that they want to be experts in self-care.”

For four decades Dr. Benson has stayed true to his goal of
changing our concept of health and well-being, using evidence-based medicine.
“I’m emeritus director, but I am still working,” he says. “It’s a title. I
still put in a full day, and I am delighted with the way things are evolving.”
Harvard Medical School has honored his many contributions with the
establishment of the Herbert Benson Professorship in Medicine, which will be
activated upon his retirement.

SIDEBAR: How to Elicit the Relaxation Response

Two basic components are involved in eliciting the
relaxation response:

  1. repeating
    a word, sound, phrase, prayer or muscular activity
  2. passively
    disregarding everyday thoughts that inevitably come to mind and returning to
    your repetition

The actual steps necessary to evoke the response are as
follows:

  1. Pick
    a focus word, sound, short phrase or prayer that is firmly rooted in your
    belief system.
  2. Sit
    quietly in a comfortable position.
  3. Close
    your eyes.
  4. Relax
    your muscles, progressing from your feet to your calves, thighs, abdomen,
    shoulders, head and neck.
  5. Breathe
    slowly and naturally, and as you do, say your focus word, sound, phrase or
    prayer silently to yourself as you exhale.
  6. Assume
    a passive attitude. Don’t worry about how well you are doing. When other
    thoughts come to mind, simply say to yourself, “Oh well,” and gently return to
    your repetition.
  7. Continue
    for 10–20 minutes.
  8. Do
    not stand immediately. Continue sitting quietly for a minute or so, allowing
    other thoughts to return. Then open your eyes and sit for another minute before
    rising.
  9. Practice
    the technique once or twice daily. Good times to do so are before breakfast and
    before dinner.

Techniques
to Elicit the Relaxation Response

diaphragmatic breathing

meditation

body scan

mindfulness

Permission to
reprint these instructions was granted by Dr. Herbert Benson.

SIDEBAR: A Sustainable “Whole-Life” Approach

A graduate of the BHI’s Lighten Up: Weight Management
program, Mary Hardy weighed more than 200 pounds and suffered from some major
life stresses when she started at the institute. She believes the program
provided her with a sustainable “whole-life” approach. “There was no ‘cookie
cutter’ prescription. They didn’t have answers. Instead they modeled the
process of personal exploration and seated it in the most up-to-date research
in nutrition, exercise and stress reduction,” she says.

Now in her mid-50s and
perimenopausal, Hardy says she feels better than she did in her 30s. Her blood
pressure and cholesterol are now normal. She is well rested, has lost 60 pounds
and says, “I am doing things I haven’t done in years—like hiking, snow shoeing,
distance swimming and biking. [BHI] helped me tap into what had personal
meaning and frame it in a healthy way of living.”

Mary Hadley, a 50-year-old who
completed the BHI’s 13-week Cardiac Wellness program as an outpatient and still
attends bimonthly sessions, is also definitive in her praise of the institute’s
methods: “That program is lifesaving. It completely changed my quality of life,
absolutely 100%. It taught me a new way to think.”

Hadley—who suffers from heart
disease, has had two surgeries for chronic back pain and has two children with
medical problems—was bedridden when she found the BHI with the assistance of
her physician. She says the institute not only helped her manage her pain but
got her moving again: “I started on the treadmill for only 3 seconds with my
cane and kept working my way up. Now I can go on the treadmill for 30 minutes
without help and without my cane. Believe me, it was a painfully slow process.”

Reflecting on her experience, Hadley affirms,
“It is an integrative program, a holistic approach; the chronic pain, the
cardiac problems and the anxiety are all considered just as important. You’re a
person with all kinds of issues, and they are there to help you with each one.” 

SIDEBAR: Resources

  • Benson, H. 1979. The Mind/Body Effect.
    New York: Simon and Schuster.
  • Benson, H., with Klipper,
    M.Z. 2000. The
    Relaxation Response.
    Updated and expanded edition. New York,
    HarperCollins.
  • Benson, H., & Proctor, W.
    2003. The Breakout
    Principle: How to Activate the Natural Trigger That Maximizes Creativity,
    Athletic Performance, Productivity, and Personal Well-Being.
    New
    York: Scribner.
  • Benson, H., with Proctor, W.
    1984. Beyond the
    Relaxation Response.
    New York: Times Books.
  • Benson, H., with Stark, M.
    1996. Timeless
    Healing: The Power and Biology of Belief.
    New York: Scribner.
  • Benson, H., & Stuart,
    E.M. (with the staff of the Mind/Body Medical Institute). 1992. The Wellness Book: The
    Comprehensive Guide to Main­taining Health and Treating Stress-Related Illness.

    New York: Citadel.
  • Casey, A., & Benson, H.
    2005. The Harvard
    Medical School Guide to Lowering Your Blood Pressure.
    New York:
    McGraw-Hill.
  • Casey, A., & Benson, H.,
    with MacDonald, A. 2004. Mind
    Your Heart: A Mind/Body Approach to Stress Management, Exercise, and Nutrition
    for Heart Health.
    New York: Free Press.

Rosalind Gray Davis is an award-winning
journalist, author and media consultant. She writes for a number of major U.S.
publications and broadcast outlets.


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